My Thoughts on Herbal Medicines

Article originally published on 26 August 2011.Edited/Updated on 25 June 2013.

Herbal medicines have likely been used for about as long as mankind has been on the Earth. They continued to be used along side more “modern” medicines for a while, but as time progressed, herbal medicines have slowly been pushed more to the fringe of modern medicine. There are a number of reasons for this, some of which I understand and some of them I don’t, but it would be foolhardy of us to dismiss herbal medicines as a whole. As a physician, it would be foolhardy of me to ignore these medicines as well.

With that said, I thought I would lend my thoughts to the subject. This can be a very heated subject, but it has been my experience that when there are two strongly opposed sides, the truth lies somewhere in between.

First:Yes, I think there is a place for herbal medicine in modern healthcare.
Yes, I am an M.D.
Yes, I think some herbal treatments work.
Yes, I instruct some of my patients to use certain herbal medicines.
No, I do not think all herbal medicines work.
No, I am not corrupted or blinded or brainwashed by the evil pharmaceutical companies.

SecondI am not going to get into specific herbs right now. I’ll save those for later articles. Now let me get started…

Statement: Modern physicians don’t like herbal medicine.My Answer: That is, by and large, true.

But why is that? To be honest, there is some indoctrination to it. As we go through our medical education, there are the random comments by some pious educators talking negatively or flat out mocking herbal medicine or those who use it. It is unfortunate, but true. Also, we occasionally see people get really sick or who die because they were relying solely on herbal medicines for treatment of their medical conditions. The vast majority of the time, these people are either very anti-establishment types (and wear a tinfoil hat to keep the government from reading their minds) or, sorry to say, are not the sharpest tool in the shed. Finally, there is limited research about herbal medicines (see my next section). These reasons generally cause a lot of physicians to remain, at the minimum, very skeptical about herbal medicine.

Statement: Doctors say there is not any research to support herbal medicine use. This is because the evil pharmaceutical companies are suppressing the truth.My Answer: The truth is there is very little good research on herbal medicine.

Here’s why: Drug companies want to make money. I know that the researchers who work for these companies truly want to help humanity. I know many of them personally. They are good people using their scientific brains to try and beat diseases the best they can. The corporate side of things is different. The management of drug companies want to turn a very healthy profit. In part, this is a good thing. The company makes drug A which treats disease 1 really well. They make a profit. They do research in disease 2. They develop drug B which really works. They make a profit. They do research…. and on and on. Overall, this model has saved millions of lives across the globe. In the U.S., whole herbs are considered food products. They cannot be patented. Which means a drug company cannot charge $150 a month for using them. Which means they have little interest in using the whole herb. Since the vast majority of research into medicine is done, or at least funded, by drug companies, and they have no interest in a specific herb since there is no return of investment, then little research is done on it.

That is not to say that no research is being done. There are grants given out every year to investigate herbal treatments. The National Institute of Health now has a Complimentary/Alternative Medicine branch to do research in herbal medicine. It has been very interesting to see their results. I must add, that the amount of high quality research into herbal medicines is growing quickly each year.

Finally, I would remiss if I did not say that the “modern” medicines are not always safe. In fact, they often are not. All medications have a potential for side effects and complications. Sometimes severe complications develop, including death. Depending on the severity of the ailment, sometimes the risk of the medicine is worth the risk of the side effects or complications.

Statement: There is a lot of research out there. You don’t like it, because it shows herbal medicine works, and you are against herbal medicine.My Answer: There is a lot of research out there. A lot of it is poorly done.

What makes research good or bad? First, good research has a lot of people in the study. What sounds more reliable: a study with 10 people or a study with 1000 people?

Second, good research uses randomization. This means you separate the people in your study into different groups at random. There are a lot of reasons why this is, and if you really want to know, I can give you a more detailed answer.

Third, good research uses a placebo and/or a third medicine. What sounds more reliable: a study that give 30 people herb X or a study that compares 10 people with herb X, 10 people with modern medicine Y, and 10 people with placebo Z. (For those that do not know, a placebo is basically a fake medicine, like a “sugar pill”)

Fourth, good research uses blinding. This means the people in the study (and in really good studies the people giving the medicine are included in the blinding) do not know if they are in the herbal medicine group, the modern medicine group, or the placebo group. Single blinding is where the subjects do not know. Double blinding is where the subject and researchers do not know (until after the study is done).

There is a lot more to it than that, but this is a good basis from which to start. In reality, most herbal medicine studies rarely fit to any of the above standards.

But you say, “I have this book that says the research shows…” In almost all cases, herbal medicine books offer very little proof that an herb works. The book may say, “It has been used for hundreds of years for…”, or “according to this herbal medicine specialist…” or “patient X used it for this disease…” Where is the proof? Who cares if it has been used for hundreds of years by the most well respected Chinese herbalists? At one time people thought tomatoes were poisonous. We believed the earth was flat! Oftentimes, tradition has little in common with truth. That is not to say these herbs do not work, it is just that tradition alone is not proof.

But you say, “This herb has been shown to kill cancer.” Lots of chemicals (including herbals) have been shown to kill cancer cells – in a petri dish! There is a huge jump to say it will work in a human body the same way it worked in a petri dish. If that is all the “research” you have, I would be very careful about using it, and I would never recommend it to others.

Statement: “My mother had cancer and took this herb, and now she is cancer free!”My Answer: I say that is wonderful! But how do you know it was the herb that did it?

In medicine, we are still learning how the immune system works and how the body repairs itself. Would your mother have beat the cancer on her own anyway? Was it that she stopped eating fast food and started exercising more? Was it the chemo? Was it people praying for her?

Whenever we have a story about herb X doing something for one person. We call it anecdotal. Practicing anecdotal medicine is very dangerous. People die when we treat a disease a way that has not been studied well. When we hear a bunch of stories about herb X healing people, that gets our attention. If it is believable, and preliminary studies (good research) shows there may be something to it, drug companies often jump into the game and try to isolate the chemical in the herb that is working. That is how we got salicylic acid from willow bark (we now know it as aspirin). I would love for the research to be done by people other than the drug companies so that the information would be more readily shared.

Statement: Herbs are safe because they are natural.My Answer: This is one of the most dangerous myths about herbal medicine.

Water is natural.
Water in the right place, in the right amount, without contaminants, is safe.
Water in the wrong place (lungs) kills people every year – drowning.
Consuming too much water kills people every year – water toxicity.
Consuming water with contaminants kills people every year – poisoning.
And this is just water, not a plant with so many more complicated chemicals

Hemlock (Conium maculatum) is a plant. It is natural. It is deadly in small amounts.
Rhubarb (Rheum rhabarbarum) is a plant. The leaf stalks are a common and delicious food. The leaves contain poisonous substances that can, in an extreme event, kill a person.
Mango (Mangifera species) are one of my favorite fruits. My brother could possibly die if he consumes mangoes, because he is allergic to them.
Stinging Nettle (Urtica dioica) is a wonderful Spring green… when cooked. Handle it the wrong way before it is heated, and you will understand why it it called Stinging Nettle.

If a person is taking an herb, they expect it to do something to their body… or else they wouldn’t take it. If it does something to their body, then it is what we call bioactive. Anything that is bioactive has a potential to interfere with a body’s normal function. That is the whole point! We want the herb (or other medicine) to do something to our bodies. We hope it is a good thing, something that will help us. Bioactive compounds can have side effects. They can interact with other medicines. People can have allergic reactions to them. People can die from the wrong dose, the wrong application, from a contaminant, from mistaking one herb for another… the list goes on.

Just because a herbal medicine is from a plant does NOT mean it is safe.

Statement: This herb will always work for this condition.My Answer: If someone tells you this, they are usually lying (either on purpose to sell you something, or because they are misinformed).

Plants are very dynamic life forms. There is so much involved into why a plant produces certain chemicals or not. The French have a term for it: terroir. They used it to describe all the geographical components of the land their grapevines grow to produce great, good, or bad wine. You can grow grapes in rich soil with certain percentages of minerals, with a certain sun/shade ratio, with a certain humidity level, with a certain amount of rain fall, with a certain temperature range, with a certain insect pest, with a certain sun angle, etc. and you will end up with fantastic grapes for wine. Or, you can grow the same grape variety in a completely different terroir, and the grapes would make terrible wine.

Herbal medicine plants often act in the same manner. One plant when grown in certain conditions may help treat a certain medical ailment, and the same species when grown in different conditions may do nothing for that ailment. This is why I believe certain well-designed research studies show an herbal medicine is effective when another equally well-designed study, but using a different source for the herb, shows the same herbal medicine is ineffective. The conditions where the plant grows may make a huge difference. This is also why the drug companies try to isolate the bioactive compounds that give certain results (and then they can patent that chemical and make money of course.)

Certain bioactive compounds in plants are very reliable, and some are very unreliable. It takes good research, great record keeping, and usually quite a bit of time and experience to know which plants will produce which bioactive compounds under which conditions. Unfortunately, this is an area in botany/medicine that is almost entirely unstudied.

Statement: I’ll go to the store and pick up a bottle of herb X.My Answer: Don’t count of Herb X being in a bottle marked Herb X.

What?! That is right. Since there is no government organization (not that we need another one!) to monitor herbal medicine content (remember, they are sold as food, not medicine), there is no guarantee that what is on the label is actually in the bottle. A very large, very well done study examined this issue. The researchers went out and bought a bunch of bottles of herbal medicines from different companies and from different stores across the U.S. The results showed that about 70% of the bottles did contain at least some form of the plant. It may have been the root or leaves or flowers; however, most samples did not specify which part. This is rather important. What if we are looking for a root or a flower, and that bottle only contains leaves? Well, then that supplement is likely worthless to us. The study also showed that 30% of the samples did not even contain the herb that was printed on the bottle! The bottom line is that there is poor quality control in the herbal medicine business. This is very unfortunate, but true.

Statement: You sound very negative about herbal medicines, but you say you tell you patients to use them. My answer: Be skeptical, and be cautious.

In an ideal world, we would know exactly how and where to grow our herbal medicine. We would know what dose to use and how to take it. We would be able to go to the store and buy the herbs we cannot grow ourselves and trust what was on the label. Right now we can do none of those things with 100% certainty.

So are are my recommendations?

Investigate the evidence for using an herb you are considering. Try to find the research and read it yourself. A lot may be technical, but you can get the general idea if it is good research or not.

Get a good book on herbal medicine side effects and interactions. The Physician’s Desk Reference for Herbal Medicines is one example of an exhaustive reference, but one of the best out there.

Grow your own herbs if you can so you know what you are actually getting. My advice is to grow your herbs in different micro-climates on your land and see which ones are better at treating the condition they are traditionally known for and you are trying to treat.

If you have to buy your herbal medicines, do your research into the company that makes it. What are their quality controls?

Let your physician know what herbs you are using, so they can help you best. If your physician says not to take it, ask them for the reasons. If they have no good reasons, which likely means that physician an anti-alternative medicine type of person, then consider finding a new physician. If they can give you a reason with evidence to support it, then strongly consider taking their advice.

So, there you have it. My thoughts on herbal medicines. In the next few weeks, I will be writing about plants that are effective as herbal medicines, how to grow them and how to safely use them.

My Grand Experiment… The Permaculture Diet (Part 1)

14 Comments

Wow! great post. i can appreciate the clear and skeptical thinking used. i’m of the belief that this type of thinking is needed in greater quantities within permaculture. looking forward to the posts on medicinal plants.

thanks for these thoughts. i agree with most of this. i tend to like treating small things with natural remedies but i agree that just because it has been used for hundreds of years it does not actually mean that it works. what disturbed me about a lot of people is that for every tiny thing they have a pill. it cant be good for you to take so many pills, antibiotics or cortisone constantly…

The biggest knock to the herbals is, of course, testing. Of course many of the herbals do work, but the exact dosages required for therapeutic results are hard to pin down. Couple this with the fact that many people ascribe to the “if one is good, two is better” mentality and you have a recipe for therapeutic failure and danger. If there were a way to capitalize more (make protected money) on herbals the testing would be there. In the future, things such as proprietary delivery systems and what not may increase the market and legitimacy of herbals. But, for now, the most important thing in any herbal or heavy vitamin users mind should be ALWAYS DISCLOSE USAGE TO YOUR PHYSICIAN OR SURGEON. I’ve seen things such as cardiologists have a BIG PROBLEM with stopping bleeding rates on the table due to ginkgo biloba usage and failure to disclose. Yes, many herbals do exact a change in the body, but this doesn’t NECESSARILY mean they “work” or are therapeutic in any way.

Other reasons for herbs apparent lack of effectiveness in some studies is dosage, and method of delivery. Herbs were used for thousands of years nibbled fresh, or in tea, honey, wine, beer or vinegar, or soup, and only more recently, in tinctures or glycerites. More recently than that they are given in capsules or pills so that they re-assure people they are like Pharma, true medicines, yet we have little or no documentation that dried herbs in capsules or tablets do any good (though Tibetan and Chinese medicines in pills have more documentation of efficacy and are usually concentrates) Some companies put extracts and concentrates of herbs in their capsules and pills, which are more likely to do some good than a few dried and chopped leaves in a teeny capsule, that a very profitable herbal company promotes ..but also are more likely to have side effects, because a determined effective compound may be concentrated without supportive compounds in the herb that would ameliorate side-effects…

Many doctors are indoctrinated to think and site the fact that you don’t know if any of the actual herbs are in the remedy, but there are hundreds of reputable herbalists who make effective tinctures and balms, and a few widely available reputable tincture-makers and capsule/tablet makers–Gaia Herbs, Planetary Herbal Formulas, and Herbs of Light, are a few of the larger, very good herbal- medicine makers.

Good herbalists do not just treat a symptom, but the whole psychological/dietary/causal profile of a client. Many herbs can treat a sore throat, but one caused by post-nasal drip from allergies, or from a fungal infection in the mouth, or a lack of good dental hygiene would be treated differently than one caused by a virus. A good herbalist may probe deeper to find if that person had been having a hard time expressing things verbally, (Dr. Christine Northrup, MD, is good at this type of whole person diagnosis in her books, which all MD’s should read.) leading to a blockage of energy in the throat. They would also look at secondary symptoms, like digestive upset, lymph congestion, sinus infection, etc to find the herb or combination of herbs to most help that person’s constitution and symptoms.

Many herbalists are trained in low-tech but sophisticated Asian diagnostic methods of tongue, face, urine, and pulse reading, that can give a very good analysis of organ, endocrine system, and lymphatic function, without expensive tests.

MD’s are also indoctrinated to think there are no peer-reviewed, double-blind herbal studies and journals, with well-designed studies, when in fact, they exist all over the world, including two journals that I know of in America, HerbalGram, and Alternative Therapies. They often site, as do many herbal books, great research done in Asia and in Europe, as well as under-funded research done here. The European E -monographs were all thoroughly researched, and are, from most herbalists standpoints, very conservative in their claims.

Herbalists who know herbs well, scientifically, experientially, and with well-founded intuitions about them, are often more dependable than pharmaceutical studies biased by being paid for by the companies hoping to profit from that drug, and documented collusion with some of the prominent medical journals. The ONLY effective means of treating some antibiotic -resistant strains of disease, and MRSA’s , including flesh-eating bacteria, is complementary medicine, whether it be maggots and leeches to effectively clean wounds, or essential oils and herbs….

Pharma drugs kill thousands of people a year, and create symptoms requiring the use of yet more drugs, often without effecting the underlying cause of symptoms, while herbs typically create few bad side effects if correctly used, as a WHOLE herb, and deaths attributed to herbs, usually incorrectly used, is one or two, often calling for discontinued use of a very effective herb because of misuse. Off-label use of Pharma drugs is at least as dangerous as using the wrong herb, or wrong part of the herb, or non-existant- in- the- formulation herb, and causes many more deaths, tragic side-effects, and ineffective treatment than herbs do…

While this SEEMS balanced, it also perpetuates many anti-herbal myths foisted upon doctors by Pharma and teachers..without ANY herbal wisdoms so beautifully gleaned by our Master herbalists…

The placebo effect is now more effective than many Pharma drugs on the market, without the side effects…almosr as effective as herbs…

Well said. As a veterinarian & beginning permie, I am looking for effective herbs that do no harm for multiple species other than humans. Not much GOOD scientific research for vets either. Makes good sense for many of my species, especially the herbivores.

A big fan, again when used in the right way. I and my wife have used it in the past. I have studied it a bit. The US military is actually training some of their docs on how to use it… it is a year long course.

Hello. Great article which reflects my experience and opinion very well. As a pediatrician and “prepper” I have felt that I needed to have a fall-back if access to pharma becomes limited or unavailable. Until that day, I happily use conventional meds! I am not, however, gifted in the writing area and would ask your permission to use your article as a handout for my patients who use herbals. I am happy to give credit. Thanks!

I’m a general practitioner (and avid gardener) in the uk and I often have this conversation with patients too! I hope you don’t mind if I share this information with my patients… It is nice to read something that is balanced and sensible about herbal medicine!

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